595 Claims Adjudication Jobs - Page 11

DesignationAssistant Operations ManagerReports to (level of category)Manager - Operations Role ObjectiveFollow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cashposting. After Denial management (AR Follow up), again the cycle starts till the payment is made by the insurance company.Essential Duties and Responsibilities: Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures. Manages people and drives retention Analysis data to identify process gaps, prepare reports Performance management First level of escalation Work in all shifts on a rotational basis Need to be cost efficient with regards to processes, resource utilization and overall constant cost management Must operate utilizing aggressive operating metrics.Qualifications:Graduate in any discipline from a recognized educational institute (Except B.Pharma, M.Pharma, Regular MBA, MCA B.Tech Freshers')Good analytical skills and proficiency with MS Word, Excel and Powerpoint (Typing speed of 30 WPM)Good communication Skills (both written & verbal) Skill Set:Candidate should be good in Denial ManagementCandidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on DenialsAbility to interact positively with team members, peer group and seniors.Subject matter expert in AR follow upDemonstrated ability to exceed performance targetsAbility to effectively prioritize individual and team responsibilitiesCommunicates well in front of groups, both large and small. Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests. Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visitr1rcm.com Visit us on Facebook

About US: R1 is a leading provider of technology-driven solutions that help hospitals and health systems to manage their financial systems and improve patients experience. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, Al, intelligent automation and workflow orchestration. R1 is a place where we think boldly to create opportunities for everyone to innovate and grow. A place where we partner with purpose through transparency and inclusion. We are a global community of engineers, front-line associates, healthcare operators, and RCM experts that work together to go beyond for all those we serve. Because we know that all this adds up to something more, a place where we're all together better. R1 India is proud to be recognized amongst Top 25 Best Companies to Work For 2024, by the Great Place to Work Institute. This is our second consecutive recognition on this prestigious Best Workplaces list, building on the Top 50 recognition we achieved in 2023. Our focus on employee wellbeing and inclusion and diversity is demonstrated through prestigious recognitions with R1 India being ranked amongst Best in Healthcare, recognized as one of Indias Top 50 Best Workplaces for Women 2024, amongst Indias Top 25 Best Workplaces in Diversity, Equity, Inclusion & Belonging 2024, Top 100 Best Companies for Women by Avtar & Seramount, and amongst Top 10 Best Workplaces in Health & Wellness. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare work better for all by enabling efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 17,000+ strong in India with presence in Delhi NCR, Hyderabad, Bengaluru, and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities. Role- Medical Coder: We are looking to hire an experienced Coder / Sr. Coder with active coding certifications (CPC / CPC-A / CIC / CCS / COC). With strong domain expertise in CPT and ICD (diagnosis) coding, the incumbent should be able to validate the coding after reviewing all relevant medical records ensuring codes are accurate and sequenced correctly in accordance with government and insurance regulations. Working in an evolving healthcare setting, delivering innovative solutions using our shared expertise. Using opportunities to learn and grow through rewarding interactions, collaboration, and the freedom to explore professional interests. Giving priority always to what is best for our clients, patients, and each other. With our proven and scalable operating model, complementing a healthcare organizations infrastructure to quickly drive sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience. Responsibilities: Assign codes to diagnoses and procedures, using ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes. Follow up with the provider on any documentation that is insufficient or unclear. Communicate with other clinical staff regarding documentation. Search for information in cases where the coding is complex or unusual. Receive and review patient charts and documents for accuracy. Review the previous day's batch of patient notes for evaluation and coding. Ensure that all codes are current and active. : Education Any Graduate. 1 to 7 Years experience in Medical Coding. Successful completion of a certification program from AHIMA or AAPC. Strong knowledge of anatomy, physiology, and medical terminology. Skilled in assigning ICD-10 & CPT codes. Solid oral and written communication skills. Able to work independently. Flexible to work from office and home as required by the business. Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests. Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visitr1rcm.com Visit us on Facebook

R1 is a leading provider of technology-driven solutions that help hospitals and health systems to manage their financial systems and improve patients experience. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, Al, intelligent automation and workflow orchestration. R1 is a place where we think boldly to create opportunities for everyone to innovate and grow. A place where we partner with purpose through transparency and inclusion. We are a global community of engineers, front-line associates, healthcare operators, and RCM experts that work together to go beyond for all those we serve. Because we know that all this adds up to something more, a place where we're all together better. R1 India is proud to be recognized amongst Top 25 Best Companies to Work For 2024, by the Great Place to Work Institute. This is our second consecutive recognition on this prestigious Best Workplaces list, building on the Top 50 recognition we achieved in 2023. Our focus on employee wellbeing and inclusion and diversity is demonstrated through prestigious recognitions with R1 India being ranked amongst Best in Healthcare, amongst Top 50 Best Workplaces for Millennials, Top 50 for Women, Top 25 for Diversity and Inclusion and Top 10 for Health and Wellness. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare work better for all by enabling efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 17,000+ strong in India with presence in Delhi NCR, Hyderabad, Bangalore, and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities. Designation Operations Manager Location: Hyderabad Reports to (level of category) Senior Operations Manager Role Objective Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cash posting. After Denial management (AR Follow up), again the cycle starts till the payment is made by the insurance company. Essential Duties and Responsibilities Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures. Day-to-day operations People Management (Work Allocation, On job support, Feedback & Team building) Performance Management (Productivity, Quality, One-On-One sessions, KRA, PIP) Reports (Internal and Client performance reports) Work allocation strategy CMS 1500 & UB04 AR experience is mandatory. Span of control - 80 to 100 Thorough knowledge of all AR scenarios and Denials Expertise in both Federal and Commercial payor mix Excellent interpersonal skills Should be capable to interact with US clients and manage escalations Qualifications Graduate in any discipline from a recognized educational institute Good analytical skills and proficiency with MS Word, Excel and PowerPoint Good communication Skills (both written & verbal) Skill Set Candidate should be good in Denial Management Candidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials. Ability to interact positively with team members, peer group and seniors. Demonstrated ability to exceed performance targets. Ability to effectively prioritize individual and team responsibilities. Communicates well in front of groups, both large and small. Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests. Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visitr1rcm.com Visit us on Facebook

About US: R1 is a leading provider of technology-driven solutions that help hospitals and health systems to manage their financial systems and improve patients experience. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, Al, intelligent automation and workflow orchestration. R1 is a place where we think boldly to create opportunities for everyone to innovate and grow. A place where we partner with purpose through transparency and inclusion. We are a global community of engineers, front-line associates, healthcare operators, and RCM experts that work together to go beyond for all those we serve. Because we know that all this adds up to something more, a place where we're all together better. R1 India is proud to be recognized amongst Top 25 Best Companies to Work For 2024, by the Great Place to Work Institute. This is our second consecutive recognition on this prestigious Best Workplaces list, building on the Top 50 recognition we achieved in 2023. Our focus on employee wellbeing and inclusion and diversity is demonstrated through prestigious recognitions with R1 India being ranked amongst Best in Healthcare, recognized as one of Indias Top 50 Best Workplaces for Women 2024, amongst Indias Top 25 Best Workplaces in Diversity, Equity, Inclusion & Belonging 2024, Top 100 Best Companies for Women by Avtar & Seramount, and amongst Top 10 Best Workplaces in Health & Wellness. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare work better for all by enabling efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 17,000+ strong in India with presence in Delhi NCR, Hyderabad, Bengaluru, and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities. Role- Medical Coder: We are looking to hire an experienced Coder / Sr. Coder with active coding certifications (CPC / CPC-A / CIC / CCS / COC). With strong domain expertise in CPT and ICD (diagnosis) coding, the incumbent should be able to validate the coding after reviewing all relevant medical records ensuring codes are accurate and sequenced correctly in accordance with government and insurance regulations. Working in an evolving healthcare setting, delivering innovative solutions using our shared expertise. Using opportunities to learn and grow through rewarding interactions, collaboration, and the freedom to explore professional interests. Giving priority always to what is best for our clients, patients, and each other. With our proven and scalable operating model, complementing a healthcare organizations infrastructure to quickly drive sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience. Responsibilities: Assign codes to diagnoses and procedures, using ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes. Follow up with the provider on any documentation that is insufficient or unclear. Communicate with other clinical staff regarding documentation. Search for information in cases where the coding is complex or unusual. Receive and review patient charts and documents for accuracy. Review the previous day's batch of patient notes for evaluation and coding. Ensure that all codes are current and active. : Education Any Graduate. 1 to 7 Years experience in Medical Coding. Successful completion of a certification program from AHIMA or AAPC. Strong knowledge of anatomy, physiology, and medical terminology. Skilled in assigning ICD-10 & CPT codes. Solid oral and written communication skills. Able to work independently. Flexible to work from office and home as required by the business. Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests. Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visitr1rcm.com Visit us on Facebook

R1 RCM India is proud to be recognized amongst India's Top 50 Best Companies to Work For TM 2023 by Great Place To Work Institute. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare simpler and enable efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 14,000 strong in India with offices in Delhi NCR, Hyderabad, Bangalore , and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities . Designation S r. Analyst /Lead Associate Reports to (level of category) Individual COA( Performance Management) Role Objective Follow up is the most essential part in the RCM cycle. It is usually the last step in the cycle after cash - posting. After Denial management (AR Follow up), again the cycle starts till the payment is made by the insurance company. Essential Duties and Responsibilities Establishes and assures compliance with departmental policies and procedures in conformance with corporate policies and procedures. Analysis data to identify process gaps, prepare reports and share findings for Metrics improvement. Able to interact independently with counterparts. Performance management First level of escalation Work in all shifts on a rotational basis WFO only Need to be cost efficient with regards to processes, resource utilization and overall constant cost management Must operate utilizing aggressive operating metrics. Qualifications Graduate in any discipline from a recognized educational institute (Except B.Pharma , M.Pharma , Regular MBA, MCA B.Tech Freshers') Good analytical skills and proficiency with MS Word, Excel and Powerpoint Good communication Skills (both written & verbal) Skill Set Candidate should be good in Denial Management Candidate should have knowledge of Medicare, Medicaid & ICD & CPT codes used on Denials Ability to interact positively with team members, peer group and seniors. Subject matter expert in AR follow up Demonstrated ability to exceed performance targets Ability to effectively prioritize individual and team responsibilities Communicates well in front of groups, both large and smal l. Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests. Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visitr1rcm.com Visit us on Facebook

Experience with customer interaction, requirements gathering, gap analysis and sound understanding of the software development lifecycle is a must Familiarity with the business processes of at least one of the verticals like Financial Services, Banking is a must Contributing best practices Ideas to the product road map. Create the test scenarios and conduct functional validation. Excellent problem solving, presentation, written and oral communication skills Interact with clients during project kick-off, requirement gathering, gap analysis workshops, end user training and product delivery Create epics and user stories Mandatory Competencies BA - BA BA - Business Knowledge BA - Client Interaction Beh - Communication BA - Conduct Trainings BA - Create Specifications BRD/ FRD

Educational Bachelor of Engineering,BCA,BSc,MTech,MCA,MSc Service Line Enterprise Package Application Services Responsibilities A day in the life of an Infoscion As part of the Infosys consulting team, your primary role would be to actively aid the consulting team in different phases of the project including problem definition, effort estimation, diagnosis, solution generation and design and deployment You will explore the alternatives to the recommended solutions based on research that includes literature surveys, information available in public domains, vendor evaluation information, etc. and build POCs You will create requirement specifications from the business needs, define the to-be-processes and detailed functional designs based on requirements. You will support configuring solution requirements on the products; understand if any issues, diagnose the root-cause of such issues, seek clarifications, and then identify and shortlist solution alternatives You will also contribute to unit-level and organizational initiatives with an objective of providing high quality value adding solutions to customers. If you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you! Additional Responsibilities: Ability to work with clients to identify business challenges and contribute to client deliverables by refining, analyzing, and structuring relevant data Awareness of latest technologies and trends Logical thinking and problem solving skills along with an ability to collaborate Ability to assess the current processes, identify improvement areas and suggest the technology solutions One or two industry domain knowledge Technical and Professional : Primary skills:Domain-Banking-Products Preferred Skills: Domain-Banking-Products-FICO(SAP)

Educational Bachelor of Engineering,BCA,BTech,MTech,MBA,MCA Service Line Application Development and Maintenance Responsibilities A day in the life of an Infoscion As part of the Infosys delivery team, your primary role would be to interface with the client for quality assurance, issue resolution and ensuring high customer satisfaction. You will understand requirements, create and review designs, validate the architecture and ensure high levels of service offerings to clients in the technology domain. You will participate in project estimation, provide inputs for solution delivery, conduct technical risk planning, perform code reviews and unit test plan reviews. You will lead and guide your teams towards developing optimized high quality code deliverables, continual knowledge management and adherence to the organizational guidelines and processes. You would be a key contributor to building efficient programs/ systems and if you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you!If you think you fit right in to help our clients navigate their next in their digital transformation journey, this is the place for you! Technical and Professional : Domain experiencePayer core – claims/Membership/provider mgmt. Domain experienceProvider clinical/RCM, Pharmacy benefit management Healthcare Business Analysts - with Agile/Safe-Agile Business analysis experience Medicaid, Medicaid experienced Business Analysts FHIR, HL7 data analyst and interoperability consulting Healthcare digital transformation consultants with skills/experience of cloud data solutions design, Data analysis/analytics, RPA solution design KeywordsClaims, Provider, utilization management experience, Pricing,Agile, BA Preferred Skills: Domain-Healthcare-Healthcare - ALL Technology-Analytics - Functional-Business Analyst

Educational Bachelor of Engineering,BTech,BCA,MBA,MTech,MCA Service Line Application Development and Maintenance Responsibilities As a ‘Senior Product Manager’ you will be pivotal to creating roadmap, owning release plan for multiple capabilities that is futuristic and meets industry and client needs. You will be responsible for continuous backlog management, prioritizing the backlog considering the needs and objectives of every stakeholder. As a thought leader in your business domain, bring in industry best practices, learnings from client demos and interactions into designing. You will anchor business pursuit initiatives, sales demo. You will have the opportunity to shape the Infosys platform that enables payers and providers to deliver better care. Additional Responsibilities: Experience in market leading healthcare products (key emphasis). Proven track record of at least 8 years in software product management roles. Capability/Feature planning and design, manage the specifications of their development, and monitor their on-going operation to better understand customer experiences. Clearly communicating progress towards delivery, technical challenges that may occur. Act as a thought leader and subject matter expert in the assigned product area, develop essential product documentation including business case, business requirements and use cases. Own product backlog and collaborate closely with the platform engineering team. Create Journey Maps that re-imagine/re-define the healthcare problematic process areas. Understanding of trends affecting customer adoption. Experience of working with enterprise customers, both technical and business, and at all levels. Influence leaders in diverse functional areas Strong business acumen including experience in estimation and pricing, market research. Demonstrated ability to navigate ambiguity and adapt quickly to modern technology and processes. Strong analytical ability with exposure to data science and automation Teaming/Collaboration - Demonstrates exceptional leadership and team management skills, with a collaborative and empowering approach to achieve results through influence. Excellent communication, presentation, and interpersonal skills to develop lasting relationships with senior business or technical leaders with the highest levels of business acumen and technical expertise. Technical and Professional : Payer/ Provider/ PBM organizations Product Management/Product Engineering /Healthcare Operations Experience working with industry leading Enrollment, Claims, Billing or EHR systems. Managing product lifecycle in whole – from ideation, exploration, approval, development, implementation, measurement, and ongoing development. Expertise in US Government Program Line of Business - Medicare, Medicaid, Duals, Marketplace Plan Sponsor & Product, Enrollment & Billing, Provider Data Management, Provider Network Management, Claims, Encounters, Medicare, and Marketplace Risk Adjustment. Developing results-oriented strategies to solve complex and open-ended business problems. Market Analysis and Product fitment Communicating and facilitating architecture design discussions/decisions and impacts to key stakeholders. Customer success on managing customer engagements and requirements. Leading business pursuits and product demonstrations. Agile Product Development Methodology Preferred Skills: Domain-Healthcare-Healthcare - ALL

Project Role : Business Analyst Project Role Description : Analyze an organization and design its processes and systems, assessing the business model and its integration with technology. Assess current state, identify customer requirements, and define the future state and/or business solution. Research, gather and synthesize information. Must have skills : Financial Processes Good to have skills : NAMinimum 3 year(s) of experience is required Educational Qualification : 15 years full time education Summary :This role involves providing comprehensive functional helpdesk support and system administration for financial and compliance control systems like Blackline and Auditboard. Key responsibilities include resolving user issues, managing system maintenance, conducting user training, and contributing to process improvement projects. The ideal candidate should have strong business acumen, knowledge of finance and accounting processes, excellent communication skills, and experience with ERP systems. The role requires working night shifts in India to align with US EST hours. Roles & Responsibilities:Provide functional helpdesk support to global users on Financial systems like Blackline and Auditboard.Resolve functional issues via the Service Now ticketing tool; route technical issues to the technical team or developers.Manage user security, perform regular maintenance tasks, update metadata, and upload FX rates.Conduct User Acceptance Testing (UAT) on applications.Implement Blackline modules across various client organizations.Provide end-user training sessions and create standard work materials, including videos and documents.Contribute to process design and transformation projects.Report technical issues and support developers on functional aspects.Expected to perform independently and become an SME. Professional & Technical Skills: Business acumen with an understanding of financial accounting fundamentals and key control indicators.Knowledge of Finance & Accounting (F&A) processes, specifically Record-to-Report.Excellent English proficiency (written and spoken) for global user interaction.Experience with various ERPs and financial systems, preferably as a system administrator.Project management experience is a strong plus.Adaptability and flexibility.Problem-solving skills.Ability to establish strong client relationships. Additional Information:The role requires working night shifts in India, aligning with US EST hours.A masters degree in finance is preferred15 years of full time Education Qualification 15 years full time education

Greeting from Medi assist TPA Pvt ltd. Hiring Medical officer for Insurance Claim processing Profile Location- Mumbai -Andheri East. Role - Medical officer Exp : 0-8 years Job description : * Check the medical admissibility of claim by confirming diagnosis and treatment details * Verify the required documents for processing claims and raise an information request in case of an insufficiency * Approve or deny claims as per T&C within TAT Interested candidate can drop there resume in my Mail ID : varsha.kumari@mediassist.in We are looking for fresher or exp candidates BAMS, BHMS- 8951865563 Whatsapp CV mail id -sarika.pallap@mediassist.in

SME Responsibilities: 1. Provide expert knowledge and guidance in medical billing procedures, coding, and compliance standards. 2. Process Improvement: Analyze existing billing processes and systems to identify opportunities for improvement in efficiency and accuracy. 3. Training and Development: Develop training materials and conduct training sessions for staff on medical billing best practices, new regulations, and software updates. 4. Audit and Compliance: Conduct regular audits to ensure billing practices comply with regulatory requirements and internal policies. 5. Quality Assurance: Implement quality assurance measures to maintain high standards of accuracy and completeness in billing documentation and submissions. 6. Research and Resolution: Research complex billing issues and provide timely resolutions to ensure prompt reimbursement and customer satisfaction. 7. Documentation and Reporting: Maintain detailed documentation of billing processes, audits, and resolutions. Prepare reports for management on key metrics and performance indicators. 8. Customer Support: Provide support to internal teams and external clients regarding billing inquiries, discrepancies, and issues. 9. Stay Updated: Stay informed about changes in medical billing regulations, coding guidelines, and industry trends to ensure compliance and best practices. 10. Collaboration: Collaborate with cross-functional teams including healthcare providers, IT professionals, and legal experts to address billing challenges and implement solutions. ** Hand on experience in ECW software preferrable**

Review and validate claims as per hospital MOU terms. Ensure accurate mapping of pricing, packages, inclusions, and exclusions. Coordinate with internal teams for issue resolutions Eligibility: BDS, BHMS, BAMS, BPT graduates. Work Type: Remote

Job Summary We are seeking a highly skilled Test Lead with 8 to 12 years of experience to join our team. The ideal candidate will have expertise in PLM Functional Knowledge and Windchill with a preference for experience in the Provider domain. This is a work-from-home position with day shifts and no travel required. The Test Lead will play a crucial role in ensuring the quality and reliability of our products contributing to the companys success and societal impact. Responsibilities Lead the testing efforts for PLM systems ensuring all functionalities meet the required standards. Oversee the development and execution of test plans and test cases for Windchill applications. Provide guidance and support to the testing team fostering a collaborative and efficient work environment. Collaborate with cross-functional teams to identify and resolve defects ensuring seamless integration of PLM solutions. Analyze test results and provide detailed reports to stakeholders highlighting areas for improvement. Ensure compliance with industry standards and best practices in all testing activities. Develop and maintain automated testing scripts to enhance testing efficiency and coverage. Monitor and evaluate the performance of testing processes implementing improvements as needed. Coordinate with development teams to ensure timely resolution of issues and defects. Contribute to the continuous improvement of testing methodologies and processes. Ensure that all testing activities align with the companys goals and objectives driving quality and innovation. Engage in knowledge sharing and training sessions to enhance team capabilities and expertise. Support the implementation of new testing tools and technologies to improve testing outcomes. Qualifications Possess strong PLM Functional Knowledge and expertise in Windchill applications. Demonstrate experience in the Provider domain is a plus. Exhibit excellent analytical and problem-solving skills. Show proficiency in developing and executing test plans and cases. Have experience with automated testing tools and methodologies. Display strong communication and collaboration skills. Maintain a proactive and detail-oriented approach to testing activities. Certifications Required ISTQB Certified Tester Windchill Certification

To ensure that all underwriting placement/ client service requirements of clients are met as per Company defined TATs Structuring and sourcing quotes for fire, marine, property, engineering, liability, motor and other miscellaneous insurance policies of clients Ensuring optimal product coverage & premium pricing Negotiating with insurers for best rates terms Vetting policy documents received from insurers in terms of terms, coverage, etc., Timely reconciliation of each account Ensuring timely updation of data details in appropriate tools solutions Effectively coordinating between client insurers for any document collection handover Effectively coordinating with the TPA for daily service requirements Communicating with internal & external stakeholders as needed based on business requirements Accountable for deliverables pertaining to the areas assigned and responsible for results Background in underwriting of non-retail insurance products in essential Knowledge on marine & property underwriting is necessary Basic knowledge of premium pricing and product coverage Good communication skills Multi-tasking & prioritizing Strong interpersonal skills Networking & Collaborative Abreast with technology

We are seeking a dedicated and detail-oriented Appeals & Grievances Processor with a strong background in the US healthcare payor sector. This role involves working as part of a team to resolve complex member and provider issues related to appeals and grievances, ensuring compliance with Medicare, Medicaid, and health plan standards. Minimum Qualifications: 2+ years of experience in the US healthcare payor sector. 1+ year of experience in processing appeals and grievances. Strong understanding of denial management and claims adjudication. Experience with Medicare and Medicaid from the payor side. Responsibilities: Analyze and resolve member and provider appeals, grievances, and disputes in compliance with regulatory requirements. Prepare and organize case research, notes, and documents. Communicate effectively with members and providers, both verbally and in writing. Obtain and review medical records, notes, and bills to apply contract language and benefits. Conduct research and analysis to recommend appropriate actions for management review. Determine the root cause of payment errors and resolve them using support systems. Compose concise and accurate correspondence regarding appeals and grievances. Collaborate with provider and member services to address balance bill issues and complaints. Ensure timely and appropriate responses per state, federal, and health plan guidelines. Meet departmental production standards. Prepare appeal summaries and document findings, including trend information as needed. Preferred Knowledge/Skills: Strong verbal and written communication skills, including letter writing. Proficiency in Microsoft Word, Excel, and PowerPoint. Excellent organizational, interpersonal, and time management skills. Attention to detail and ability to prioritize tasks and work under firm deadlines. Enthusiastic team player with the ability to interact successfully with members, medical professionals, and government representatives. Familiarity with the Pega computer system is a plus. Certifications: No specific certifications required. Additional Information: This position requires 100% work from the office. The role operates during night shifts to accommodate client and organizational needs.

Job Summary - A career in our Managed Services team will provide you an opportunity to collaborate with a wide array of teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology. Our Appeals and Grievances Managed Services (AGMS) team will provide you with the opportunity to act as an extension of our healthcare clients' business office. We specialize in appeal and grievances functions and addressing member complaints for health plans and their business partners. We leverage our clients customized workflows and associated automations in conjunction with clients data advanced data analysis and quality assurance processes to enable our clients to achieve better compliant results, which ultimately allows them to provide better services to their members. Required Field of Study (BQ): Any Graduation Minimum Year(s) of Experience : US 2+ years of experience in US Health care Payor side Required Knowledge/Skills (BQ): US Healthcare Experience Experience in Appeals & Grievances (A&G, Medicare/Medicaid) Preferred Knowledge/Skills *: Strong verbal and written communication skills, including letter writing experience. Excellent English skills with the ability to read, comprehend, write and communicate verbally with stakeholders & customers. Ability to work with firm deadlines, multi-task, set priorities and pay attention to details Ability to successfully interact with members, medical professionals, health plan and government representatives. Knowledge on Appeals & Grievances and Medicare/Medicaid Proficiency with Microsoft Word, Excel, and PowerPoint. Excellent organizational, interpersonal and time management skills. Must be detail-oriented and an enthusiastic team player. Knowledge of Pega computer system a plus. Responsibilities: As an Associate, youll work as part of a team of problem solvers with consulting and industry experience, helping our clients solve their complex member, provider and business issues. Specific responsibilities include, but are not limited to: Analyzes, evaluates and resolves member & provider appeals, disputes, grievances, and/or complaints from health plan members, providers and related outside agencies in accordance with the standards and requirements established by the Centers for Medicare and Medicaid and/or health plan. Prepares and organizes case research, notes, and documents. Contacts the member/provider through written and verbal communication. Requests, obtains and reviews medical records, notes, and/or detailed bills as appropriate. Applies contract language, benefits, and review of covered services. Conducts research, fact checking and analysis and recommends appropriate course of action and next steps for management review. Research claim / service authorization appeals and grievances using support systems to determine appeal and grievance outcomes inclusive of claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error. Determines appropriate language for letters and composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements. Communicates resolution to members (or authorized) representatives. Works with provider & member services to resolve balance bill issues and other member/provider complaints. Assures timeliness and appropriateness of responses per state, federal and health plan guidelines. Responsible for meeting production standards set by the department. Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested. Desired Knowledge / Skills: 2+ years of experience in US Health care Payor side 1 + years of processing experience in Appeals & Grievance Denial Management Knowledge on US Health Care, Claims Adjudication, Rework & A&G Experience Level: 2+ years Shift timings: Flexible to work in night shifts (US Time zone)

Skill required: Property & Casualty- Claims Processing - Insurance Claims Designation: Claims Management New Associate Qualifications: Any Graduation Years of Experience: 0 to 1 years About Accenture Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song all powered by the worlds largest network of Advanced Technology and Intelligent Operations centers. Our 699,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. Visit us at www.accenture.com What would you do We help insurers redefine their customer experience while accelerating their innovation agenda to drive sustainable growth by transforming to an intelligent operating model. Intelligent Insurance Operations combines our advisory, technology, and operations expertise, global scale, and robust ecosystem with our insurance transformation capabilities. It is structured to address the scope and complexity of the ever-changing insurance environment and offers a flexible operating model that can meet the unique needs of each market segment.Claim processing team collects end-end data dataDevelop and deliver business solutions that support the claims process across its lifecycle, including first notice of loss, claims investigation, payment administration or adjudication, provider reimbursement (health care), subrogation and recovery. What are we looking for Claims ProcessingProperty and Casualty Insurance Roles and Responsibilities: In this role you are required to solve routine problems, largely through precedent and referral to general guidelines Your primary interaction is within your own team and your direct supervisor In this role you will be given detailed instructions on all tasks The decisions that you make impact your own work and are closely supervised You will be an individual contributor as a part of a team with a predetermined, narrow scope of work Please note that this role may require you to work in rotational shifts Qualification Any Graduation

Project Role : Business Analyst Project Role Description : Analyze an organization and design its processes and systems, assessing the business model and its integration with technology. Assess current state, identify customer requirements, and define the future state and/or business solution. Research, gather and synthesize information. Must have skills : Microsoft Dynamics 365 Operations Functional Good to have skills : NAMinimum 5 year(s) of experience is required Educational Qualification : 15 years full time education Summary :As a Business Analyst, you will engage in a variety of tasks that involve analyzing organizational processes and systems. Your typical day will include assessing the current state of business models, identifying customer requirements, and defining future states or business solutions. You will conduct research, gather data, and synthesize information to support decision-making and improve operational efficiency. Collaboration with various stakeholders will be essential as you work to align business needs with technological capabilities, ensuring that solutions are both effective and sustainable. Roles & Responsibilities:- Expected to perform independently and become an SME.- Required active participation/contribution in team discussions.- Contribute in providing solutions to work related problems.- Facilitate workshops and meetings to gather requirements and feedback from stakeholders.- Document business processes and workflows to ensure clarity and alignment across teams. Professional & Technical Skills: - Must To Have Skills: Proficiency in Microsoft Dynamics 365 Operations Functional.- Strong analytical skills to assess business needs and translate them into functional requirements.- Experience with process mapping and documentation techniques.- Ability to communicate effectively with both technical and non-technical stakeholders.- Familiarity with project management methodologies and tools. Additional Information:- The candidate should have minimum 3 years of experience in Microsoft Dynamics 365 Operations Functional.- This position is based at our Hyderabad office.- A 15 years full time education is required. Qualification 15 years full time education

Interacting with patients in a compassionate and empathetic manner, explaining the purpose of the sleep test, and providing clear instructions on how to use the device properly Setting up the sleep testing device at the patient's home, ensuring it is functioning correctly, and providing thorough instructions on how to operate it safely and effectively Troubleshooting and Repairs: Diagnose technical issues with medical devices, identify root causes, and implement timely repairs to minimize downtime

Location: Chennai Shift : US Shift Timing (6.30PM 3.30AM) Job Qualification : Looking for voice process only. Experience in Claims Operations Candidate should have good communication skills. Responsibilities : End to End domain knowledge on US Healthcare and Payer Services life Cycle. Knowledge on Payer workflows like Enrollment, Claims Adjudication, Appeals and Grievances, Payment Integrity & Authorization Expertise on Payer terminologies (Related to Medicare Advantage programs) and concepts like Credentialing, Authorization, Out of network and In Network concepts & Subrogation. Basic knowledge on Revenue Cycle Management Interested candidates Contact : kowsalya.k HR (8122343331)

Graduate 7-8 years of relevant exp Responsible for end-to-end claims adjustor Flexible with rotational shifts Excellent communication skills

To be liaison between the patient, the hospital, and TPA, managing claim processing by coordinating with the TPA to facilitate timely claim settlements and patient billing, all while adhering to insurance guidelines and regulations.

Primary Responsibilities: Achievement of individual productivity and quality standards Contribute to working on Volumes when required and asked by the Management or Stakeholder Examining and identifying overpayments in claims, securing savings through recovery, and communicating effectively (in both written and spoken forms) to confirm and retrieve overpayments. Keeping recovery records updated with accurate information and documentation is also required Be able to learn and adapt to various claim system platforms and analyze claim payments for validation of potential other payor liability Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so Required Qualifications: 2+ years of experience using E&I & M&R claims platform 2+ years of health care experience working with claims data and / or medical codes 2+ years of experience with medical claims auditing and researching medical claims information 2+ years of experience working with processing and reviewing medical claims platforms Experience analyzing large data sets to determine trends or patterns Experience reading and interpreting clinical coding guidelines, provider contracts, fee schedules, and claim payment policies Experience within the UHC healthcare environment and systems Knowledge and understanding of medical claims terminology, CPT-4, J-codes, and ICD Diagnosis procedure codes Computer proficiency in Microsoft Office including Word (create documents), Excel (data entry) and Outlook (send email / calendar utilization) Proven ability to work under high production and quality standards At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission. #njp #SSCorp

Job description R1 RCM India is proud to be recognized amongst India's Top 50 Best Companies to Work Fo2023 by Great Place To Work Institute. We are committed to transform the healthcare industry with our innovative revenue cycle management services. Our goal is to make healthcare simpler and enable efficiency for healthcare systems, hospitals, and physician practices. With over 30,000 employees globally, we are about 14,000 strong in India with offices in Delhi NCR, Hyderabad, Bangalore, and Chennai. Our inclusive culture ensures that every employee feels valued, respected, and appreciated with a robust set of employee benefits and engagement activities. Responsibilities: Follow up with the payer to check on claim status. Responsible for calling insurance companies in USA on behalf of doctors/physicians and follow up on outstanding accounts receivables. Identify denial reason and work on resolution. Save claim from getting written off by timely following up. Candidates must be comfortable with calling on denied claims. Interview Details: Interview Mode: Face-to-Face Interview Walk-in Day : 28th June, Friday Walk in Timings : 1 PM to 4 PM Walk in Address: Candor Tech Space Tower No. 3, 6th Floor, Plot 20 & 21, Sector 135, Noida, Uttar Pradesh 201304 Contact Person-Nasar Arshi 926377969 We are hiring for RCM/US Healthcare experience only Desired Candidate Profile: Candidate must possess good communication skills. Only Immediate Joiners can apply & Candidate must be comfortable working for Gurgaon location. Provident Fund (PF) Deduction is mandatory from the organization worked. B. Tech/B.E/LLB/B.SC Biotech or Candidates Pursuing regular Graduation/Post Graduation aren't eligible for the Interview. Undergraduate (People who are not a graduate) should have Min. 12 Months Exp. Candidate should have at least 12 months of RCM experience. Benefits and Amenities: 5 days working. Both Side Transport Facility and Meal. Apart from development, and engagement programs, R1 offers transportation facility to all its employees. There is specific focus on female security who work round-the-clock, be it in office premises or transport/ cab services. There is 24x7 medical support available at all office locations and R1 provides Mediclaim insurance for you and your dependents. All R1 employees are covered under term-life insurance and personal accidental insurance.